Jemds.

com Original Research Article

A Study of Relationship of Bone Mineral Density with Age,

Body Mass Index, Obesity and Serum Magnesium Level
Jyoti Jaiswal1, Anchala Mahilange2

1, 2 Department of Obstetrics and Gynaecology, Pt. Jawaharlal Nehru Memorial

Medical College, Raipur, Chhattisgarh, India.

ABSTRACT

BACKGROUND
Menopause is defined as the permanent cessation of menstruation following loss of Corresponding Author:
ovarian activity. One of the most important problems associated with menopause is Dr. Anchala Mahilange,
Assistant Professor,
osteoporosis. This study was conducted to evaluate the relationship between bone
F18, Doctors Quarter,
mineral density, body mass index, age, serum calcium, and serum magnesium in 120 Medical College Raipur,
women. Chhattisgarh, India.
E-mail: amahilange@gmail.com
METHODS
Present study was an observational study done from Feb 2017 to July 2017 in Pt. DOI: 10.14260/jemds/2021/327
J.N.M. Medical College to evaluate the relationship of bone mineral density with age,
body mass index (BMI), obesity and serum magnesium in 120 postmenopausal How to Cite This Article:
Jaiswal J, Mahilange A. A study of
women. A detailed medical, obstetrical, menstrual, and drug history was recorded in
relationship of bone mineral density with
a proforma designed for the study. Past fracture history, family history of fracture age, body mass index, obesity and serum
and osteoporosis, socioeconomic status, occupation, educational level and weight- magnesium level. J Evolution Med Dent Sci
bearing exercises were collected and recorded. 2021;10(21):1563-1566, DOI:
10.14260/jemds/2021/327
RESULTS
Average age of women with normal bone health was 30.5 + 0.58 years, while the age Submission 25-10-2020,
Peer Review 25-03-2021,
of osteopenic and osteoporotic women was 43.11 + 6.79 years and 54.64 + 11.92
Acceptance 31-03-2021,
years respectively. Most of the osteopenic women belonged to the age group of 40 – Published 24-05-2021.
49 years. Osteoporotic patients (78.57 %) had a high (> 0.85) waist-hip ratio, while
women with normal bone mineral density had a normal waist-hip ratio. Most of the Copyright © 2021 Jyoti Jaiswal et al. This is
women with normal bone mineral density (100 %), osteopenia (85.29 %) and an open access article distributed under
osteoporosis (57.14 %) had normal serum magnesium levels. Creative Commons Attribution License
[Attribution 4.0 International (CC BY 4.0)]
CONCLUSIONS
We found that the bone mineral density reduced with advancing age, decreasing BMI
and obesity, while we found no correlation of serum magnesium level with bone
mineral density (BMD).

KEY WORDS
Bone Mineral Density, Body Mass Index, Perimenopause, Magnesium, Calcium

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Jemds.com
BACKGROUND
Menopause is defined as the permanent cessation of
menstruation following loss of ovarian activity.1 One of the
most important problems associated with menopause is
osteoporosis. Osteoporosis is the most common metabolic
bone disease and it affects up to 40 % of postmenopausal
women.2 Peak bone mass is achieved in 3rd decade of life.
Approximately, 50 % of bone loss occurs in 5 to 7 years of
menopause,3 as due to menopause there is lack of oestrogen
which leads to increase in osteoclastic activity of bone. A more
recent definition from the National Institutes of Health (NIH)
consensus development panel on osteoporosis defines
osteoporosis as a skeletal disorder characterised by
compromised bone strength predisposing a person to an
increased risk of fracture.2 Osteoporosis is caused by
imbalance between bone formation and bone resorption. Bone
mineral density is a quantitative measure of bone mass and
represents the total mineral in a selected volume of bone in hip
or in spine.4 Bone mineral density is considered to be the
standard measure for diagnosis of osteoporosis and the
assessment of fracture risk. Majority of fragility fractures
occur in patients with bone mineral density in the osteopenic
range. Study group meeting of World Health Organization
(WHO) assessed fracture risk and applied it to screen
postmenopausal osteoporosis, and recorded that more than
75 million people in US, Europe and Japan were suffering from
osteoporosis in 2006. Osteoporosis is a multifactorial disease.
Several studies have shown that in addition to risk factors such
as aging, lack of physical activity, smoking, premature
menopause, family history, poor diet and low intake of calcium
and vitamin D, other factors including body weight and body
mass index (BMI) are also important in the risk assessment
tools, which contribute to osteoporosis and osteoporotic
fracture risk.4 Low BMI and low weight are also associated
with occurrence of osteoporosis. In several studies on
different species, dietary magnesium (Mg) restriction
promotes osteoporosis. Bones of Mg deficient animals are
brittle and fragile.5 Micro fracture and trabeculae can be
detected and mechanical properties are severely impaired. So,
Mg deficient diet could be a factor which can lead to
osteoporosis. Present observational study was conducted in
obstetrics and gynaecology department of Pt. J.N.M. Medical
College to see the correlation of bone mineral density with age,
body mass index (BMI), obesity and serum magnesium.
Objective s
Find relationship between bone mineral density with body
mass index, age and serum calcium and serum magnesium in
120 women.
METHODS
The present study was an observational study, which was
conducted in the Department of Obstetrics and Gynaecology,
Pt. J.N.M. Medical College and Hospital Raipur, India. The study
was conducted among 120 postmenopausal women.
A detailed medical, obstetrical, menstrual and drug history
was recorded in a proforma designated for the study.
J Evolution Med Dent Sci / eISSN - 2278-4802, pISSN - 2278-4748 / Vol. 10 / Issue 21 / May 24, 2021
Original Research Article
Information on past fracture history, family history of fracture
and osteoporosis, socioeconomic status, occupation,
educational level and weight-bearing exercises was collected
and recorded.
BMI: Weight and height were measured through standard
methods and BMI was calculated by dividing weight
(kilogram) by height square (square meter).
Classified by Asian pacific classification-
Underweight - < 18.5 Kg / m2
Normal - 18.5 - 22.9 Kg / m2
Overweight – 23 - 24.9 Kg / m2
Class 1 obese - > 25 Kg / m2
Waist / hip ratio-waist circumference was taken by
positioning the tape just above iliac crest parallel to the floor
(in centimetre). Hip circumference was measured by widest
part of hip (in centimetre). The ratio was calculated. Then
classified as (WHO classification6)
< 0.80 - low risk
0.81 - 0.85 - moderate risk
> 0.85 - high risk
The bone mineral density was measured by bone
densitometer and classified as normal, osteopenia and
osteoporosis according to T-score. Based on WHO
classification4, individuals with T-score values higher than − 1
were classified as normal -
 Those with T-score between − 1 and − 2.5 as osteopenic
 Those with T-score less than − 2.5 as osteoporotic.
Serum mineral was measured in auto-analyser. Blood
samples were collected in tubes for estimations of calcium and
magnesium after an overnight fast. Calcium and magnesium
were estimated by using commercially available kits in
ChemWell automated analyser. All post-menopausal women
were included in the study.
E x c l u si o n C r i t e r i a
Post-menopausal women with secondary causes of decreased
BMD or any other chronic illnesses such as hyperthyroidism,
diabetes mellitus, renal or liver disease, rheumatoid arthritis
or a history of treatment with levothyroxine, furosemide,
heparin, phenytoin, phenobarbital, vitamin K, ranitidine,
corticosteroids, alcohol consumption, those having history of
fractures, bone deformity and surgical operations were not
included in the study.
S t a t i s t i c a l A n a l y si s
Data was entered to Microsoft Access Databank, and analysed
using Statistical Package for the Social Sciences (SPSS) 13.0 for
Windows (SPSS, Chicago, IL) based on a Pair-wise approach. P-
values lower than 0.01 were considered statistically
significant. Categorical variables were expressed as
percentages and compared using chi-square. Differences
among means were investigated by analysis of variance
(ANOVA) with post-hoc test.
RESULTS
Table 1 shows that the average age of women with normal
bone health was 30.5 + 0.58 years, while the age of osteopenic
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Jemds.com Original Research Article
and osteoporotic women was 43.11 + 6.79 years and 54.64 + underweight, 35.29 % were overweight and 5.88 % were class
11.92 years respectively. This showed that there was I obese.
statistically significant (P-value < 0.0001) correlation of age
with bone mineral density. Table 1 also shows that average BMI
Normal Osteopenia Osteoporosis Total
BMI of osteoporotic group was 16.32 + 2.08 while BMI of (N = 4) (N = 102) (N = 14) (120)
Underweight (< 18.525 11 (10.78 %) 12 (85.71 %)
women with normal bone health was 20.98 + 2.47 which kg / m2)
0
(47.82 %) (52.17 %)
23 (19.67 %)

showed statistically significant (P-value < 0.0001) correlation Normal (18.5 - 22.925 kg 4 (100 %) 49 (48.03 %) 2 (14.28 %)
55 (45.83 %)
/ m2) (7.27 %) (89.09 %) (3.63 %)
of low BMI with low BMD.
Overweight (23 - 24.925 36 (35.29 %)
Average age of women with normal bone health was 30.5+ 0 0 36 (30 %)
kg / m2) (100 %)
0.58 years, while the age of osteopenic and osteoporotic Class 1 obese (> 25 kg /
0 6 (5.88 %) 0 6 (5 %)
m2)
women was 43.11 + 6.79 years and 54.64 + 11.92 years
Table 4. Correlation of BMI with BMD
respectively. There was statistically significant (P-value < χ2 = 49.975, degree of freedom = 6, χ2 / degree of freedom= 8.33, P (χ2 >
0.0001) correlation of increasing age with bone mineral 49.975) = < 0.05
density. There was no statistical difference in value of calcium
level (mg / dl) in blood of normal, osteopenic and osteoporotic Serum
Normal Osteopenia
group of women. Magnesium Osteoporotic (N = 14)
(N = 4) (N = 102)
Level
1 (0.98 %)
Normal Osteopenia Osteoporosis < 1.7 (N = 1) 0 0
F (100 %)
Bone Health Group Group P-Value 4 (100 %) 87 (85.29 %) 8 (57.14 %)
Value 17 - 2.2 (N = 99)
(N = 4) (N = 102) (N = 14) (4.04 %) (87.87 %) (8.08 %)
Age (year) 30.5 + .58 43.11 + 6.79 54.64 + 11.92 21.55 < .0001 14 (13.72 %) 6 (42.85 %)
> 2.2 (N = 20) 0
BMI (kg / m2) 20.98 + 2.47 23.42 + 10.93 16.32 + 2.08 20.45 < .0001 (70 %) (30 %)
Ca (mg / dl) 9.9 + .23 9.60 + 1.35 10.04 + .13 .82 .44 Table 5. Correlation of Serum Magnesium Level with BMD
Mg (mg / dl) 2.1 + .11 2.05 + .21 2.25 + .11 6.15 < .05
χ2= 8.471, degree of freedom = 4, P = 0.07
Table 1. Baseline Characteristics in Women with
Osteoporosis and Osteopenia
Values are calculated through Analysis of variance with post hoc test Table 5 shows that most of the women with normal bone
mineral density (100 %), osteopenia (85.29 %) and
Normal Osteopenia Osteoporotic osteoporosis (57.14 %) had normal serum magnesium level.
Variable
(N = 4) (N = 102) (N = 14)
4 (100 %) 31 (30.39 %)
30 – 39 (N = 35) 0
(3.33 %) (88.57 %)
51 (50 %) 4 (28.57 %)
40 – 49 (N = 55) 0 D I SC U S SI O N
(92.72 %) (7.27 %)
Age
19 (18.62 %) 5 (35.71 %)
50 – 59 (N = 24) 0
(79.16 %) (20.83 %)
1 (0.98 %) 5 (35.71 %) Osteoporosis is a public health problem worldwide and is a
> 60 (N = 6) 0
(16.66 %) (83.33 %) common disease in the older population, especially in
Table 2. Correlation of Age with Bone Mineral Density postmenopausal women. In this study, prevalence of
χ2 = 46.682 degree of freedom = 6, P-value < .05
osteopenia (85 %) and osteoporosis (11.67 %) was very high,
may be due to most women belonging to lower socioeconomic
Table 2 shows that all the patients with normal bone
status with nutritional deficiency and lack of awareness. A
mineral density belonged to the age group of 30 – 39 years.
number of studies have been conducted in countries of the
Most of the osteopenic women belonged to the age group of 40
Middle East; the prevalence of osteoporosis was estimated to
– 49 years and all the osteoporotic women’s age was more than
be ranging from 13 - 31 % in women. Several studies have
40 years.
shown that in addition to risk factors such as aging, lack of
physical activity, smoking, premature menopause, family
Normal Osteopenia Osteoporotic
Variable
(N = 4) (N = 102) (N = 14)
history, poor diet and low intake of calcium and vitamin D,
< .80 (low risk) 2 (50 %) 49 (48.03 %) 2 (14.28 %) other factors like BMI and weight are also important risk
(N = 53) (3.77 %) (92.45 %) (3.77 %) assessment tools, which contribute to osteoporosis and
.81 - .85
Waist / hip
(moderate risk)
2 (50 %) 29 (28.43 %) 1 (7.14 %) osteoporotic fracture risk.4 Calcium and vitamin D has definite
ratio (6.25 %) (90.62 %) (3.12 %)
(N = 32) role in bone formation while other nutrient like magnesium
> .85 (high risk) 24 (23.52 %) 11 (78.57 %)
might have some role in bone metabolism. Mg and Ca are
(N = 35) (68.57 %) (31.42 %)
Table 3. Correlation of Waist Hip Ratio with BMD closely related due to the presence of approximately 50 - 60 %
χ2 = 20.13 degree of freedom = 4, P-value = < .05 of total Mg in the bones along with calcium phosphate. Mg is
an important ion due to its catalytic activity in the various
Table 3 shows that 78.57 % of osteoporotic women had metabolic process. So, evaluation of Mg might be helpful in
waist hip ratio of > .85, while women with normal bone health bone homeostasis, especially in post-menopausal women with
had waist hip ratio < .85, which showed statistically significant osteopenia and osteoporosis.
correlation of high waist hip ratio with low bone mineral Some studies showed that BMD reduce with advancing age
density. as shown in this study.7,8,9 In our study we found about 70 %
Table 4 shows that 85.71 % of the osteoporotic women of osteoporotic women were over the age of 50 year. 83.33 %
were underweight (BMI < 18.5), while women with normal of osteoporotic women belonged to the age group of more than
bone mineral density had a normal BMI. 48.03 % of the 60 year, while small number of women who had normal BMD
osteopenic women had normal BMI, 10.78 % were belonged to < 40 year of age group. (P-value < 0.05). With
advancing age, bone resorption is faster than the new bone

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Jemds.com Original Research Article
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